University of California, San Diego, Department of Pediatrics, Section of Respiratory Medicine, 9500 Gilman Dr., MC 0735, La Jolla, CA 92093, USA.
J Appl Physiol (1985). 2010 Jul;109(1):203-10. doi: 10.1152/japplphysiol.00610.2009. Epub 2010 Apr 1.
permissive hypercapnia, a stretch-limiting ventilation strategy, often results in high Pa(CO(2)). This strategy is associated with reduced morbidity and mortality in premature infants and its benefits have been attributed to diminished barotrauma. However, little is known about the independent effect of high CO(2) levels during the lung development.
mice were exposed to 8% CO(2) or room air for 2 wk either from postnatal day 2 through 17 or as adults (approximately 2 mo of age). Lungs were excised and processed for protein, RNA, histology, and total lung volumes.
histologic analysis demonstrated that alveolar walls of CO(2)-exposed mouse pups were thinner than those of controls and had twice the total lung volume. Molecular analysis revealed that several matrix proteins in the lung were downregulated in mouse pups exposed to hypercapnia. Interstitial collagen type I alpha1, type III alpha1, elastin and fibronectin protein, and mRNA levels were less than half of controls while collagen IV alpha 5 was unaffected. This decrease in interstitial collagen could thus account for the thinning of the interstitial matrix and the altered lung biomechanics. Matrix metalloproteinase (MMP)-8, a collagenase that has specificity for collagen types I and III, increased in hypercapnic mouse pups, suggesting increased collagen degradation. Moreover, tissue inhibitor of MMP (TIMP)-1, a potent inhibitor of MMP-8, was significantly decreased. However, unlike pups, adult mice exposed to hypercapnia demonstrated only a mild increase in total lung volumes and did not exhibit similar molecular or histologic changes.
although permissive hypercapnia may prevent lung injury from barotrauma, our study revealed that exposure to hypercapnia may be an important factor in lung remodeling and function, especially in early life.
允许性高碳酸血症,一种限制拉伸的通气策略,常导致高碳酸血症(PaCO2)。该策略与早产儿发病率和死亡率降低相关,其益处归因于减少气压伤。然而,人们对肺发育过程中高 CO2 水平的独立影响知之甚少。
将小鼠暴露于 8% CO2 或室内空气 2 周,从出生后第 2 天到第 17 天或作为成年人(约 2 个月大)。切除肺并进行蛋白质、RNA、组织学和总肺容量处理。
组织学分析表明,暴露于高碳酸血症的小鼠肺泡壁比对照组薄,总肺容量是对照组的两倍。分子分析表明,暴露于高碳酸血症的小鼠肺部的几种基质蛋白下调。间质胶原 I 型 alpha1、III 型 alpha1、弹性蛋白和纤维连接蛋白的蛋白和 mRNA 水平均低于对照组的一半,而 IV 型 alpha5 不受影响。因此,间质胶原的减少可以解释间质基质的变薄和改变的肺生物力学。基质金属蛋白酶(MMP)-8,一种对 I 型和 III 型胶原具有特异性的胶原酶,在高碳酸血症小鼠中增加,表明胶原降解增加。此外,基质金属蛋白酶抑制剂(TIMP)-1,一种 MMP-8 的有效抑制剂,显著减少。然而,与幼鼠不同,暴露于高碳酸血症的成年小鼠仅表现出总肺容量的轻度增加,并且没有表现出类似的分子或组织学变化。
尽管允许性高碳酸血症可能防止气压伤引起的肺损伤,但我们的研究表明,暴露于高碳酸血症可能是肺重塑和功能的一个重要因素,尤其是在生命早期。